Search

The combination of visual assessment of whole body [18F]FDG PET images and evaluation of bone marrow samples by Multiparameter Flow Cytometry (MFC) or Next-Generation Sequencing (NGS) is currently the most common clinical practice for the detection of Measurable Residual Disease (MRD) in Multiple Myeloma (MM) patients. In this study, radiomic features extracted from the bone marrow biopsy locations are analyzed and compared to those extracted from the whole bone marrow in order to study the representativeness of these biopsy locations in the image-based MRD assessment. Whole body [18F]FDG PET of 39 patients with newly diagnosed MM were included in the database, and visually evaluated by experts in nuclear medicine. A methodology for the segmentation of biopsy sites from PET images, including sternum and posterior iliac crest, and their subsequent quantification is proposed. First, starting from the bone marrow segmentation, a segmentation of the biopsy sites is performed. Then, segmentations are quantified extracting SUV metrics and radiomic features from the [18F]FDG PET images and are evaluated by Mann–Whitney U-tests as valuable features differentiating PET+/PET− and MFC+ /MFC− groups. Moreover, correlation between whole bone marrow and biopsy sites is studied by Spearman ρ rank. Classification performance of the radiomics features is evaluated applying seven machine learning algorithms. Statistical analyses reveal that some images features are significant in PET+/PET− differentiation, such as SUVmax, Gray Level Non-Uniformity or Entropy, especially with a balanced database where 16 of the features show a p value 18F]FDG PET images in MRD assessment in MM patients.

La investigación tiene objetivo de analizar actividades de marketing en redes sociales de marcas más reconocidas de entidades financieras ecuatorianas, siendo importante el estudio de la relación que existe entre el entorno de marketing online, la propuesta de valor, la imagen de marca y cómo estas influyen sobre lealtad a la marca. Se utiliza el enfoque cuantitativo para la metodología, mediante la aplicación de una encuesta digital a 245 clientes de bancos, para el análisis de datos obtenidos de la muestra extraída se utilizó software estadístico: SPSS y Smart PLS 3.0, los resultados demuestran que el marketing online tiene influencia directa de manera positiva en la lealtad del cliente de bancos. Insumo importante para los gestores bancarios y para la academia.

Neurodegenerative parkinsonisms affect mainly cognitive and motor functions and are syndromes of overlapping symptoms and clinical manifestations such as tremor, rigidness, and bradykinesia. These include idiopathic Parkinson's disease (PD) and the atypical parkinsonisms, namely progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), multiple system atrophy (MSA) and dementia with Lewy body (DLB). Differences in the striatal metabolism among these syndromes are evaluated using [

Aim: The aim was to develop and implement a virtual reality tool based on eye-tracking technologies that allow to evaluate the characteristics of the gaze patterns of glaucoma patients in order to have a better understanding of the limitations that these patients experience in their daily life. Setting: This study took place on the Ophthalmology department of Hospital Clínico San Carlos, Madrid, Spain. Methods: In total, 56 participants collaborated in the study. They were divided in two groups, a group composed of 33 glaucoma patients selected by the Ophthalmology department and a control group composed of 23 healthy individuals. Both groups completed two virtual tasks while their gaze was being monitored. The first task, defined as “static” consisted in two exercises based on the observation of images. The second task, defined as “dynamic,” consisted in a virtual driving simulator. Number of fixations, fixations duration, saccades amplitude and velocity, fixations/saccades ratio, total execution time, and other specific metrics were measured. These are the total search time for the second exercise of the first task and the number of collisions for the dynamic task. In addition, the dispersion of fixations was also discussed. Results: For the two exercises of the static task, patients exhibited significative differences in terms of number of fixations ( p = 0.012 in free observation exercise), mean saccadic velocity ( p = 0.023 and 0.017), fixations/saccades ratio ( p = 0.035 and 0.04), and also the search and total execution times of the visual search exercise ( p = 0.004 and 0.027, respectively). For the dynamic task, significative differences were found on average saccades amplitude ( p = 0.02), average saccades velocity ( p = 0.03), and the number of collisions ( p = 0.02). Conclusion: The results show that eye-tracking technologies can be used as a tool for evaluating the gaze patterns of glaucoma patients and differentiate them of healthy individuals. However, further studies with a larger cohort of participants and additional tasks are needed.

Introduction: Effectiveness of e-learning diminishes without the support of a pedagogical model to guide its use. In minimally invasive surgery (MIS), this has been reported as a limitation when technology is used to deliver contents without a sound pedagogical background. Material and methods: We describe how a generic pedagogical model, the 3D pedagogy framework, can be used for setting learning outcomes and activities in e-learning platforms focused on MIS cognitive skills. A demonstrator course on Nissen fundoplication was developed following the model step-by-step in the MISTELA learning platform. Course design was informed by Kolb’s Experiential learning model. Content validation was performed by 13 MIS experts. Results: Ten experts agreed on the suitability of content structuring done according to the pedagogical model. All experts agreed that the course provides means to assess the intended learning outcomes. Conclusions: This work showcases how a general-purpose e-learning framework can be accommodated to the needs of MIS training without limiting the course designers’ pedagogical approach. Key advances for its success include: (1) proving the validity of the model in the wider scope of MIS skills and (2) raising awareness amongst stakeholders on the need of developing training plans with explicit, rather than assumed, pedagogical foundations. Abbreviations: MIS: minimally invasive surgery; TEL: technology enhanced learning.

The last few years have been crucial in defining the most appropriate way to quantitatively assess [Whole body [Quantitative analysis for PET+/PET- differentiating demonstrated to be significant for most of the variables assessed with Mann-Whitney U-test such as Variance, Energy, and Entropy (p-value = 0.001). Moreover, the quantitative analysis with a balanced database evaluated by Mann-Whitney U-test revealed in even better results with 19 features with p-values0.001. On the other hand, radiomics analysis for MFC+/MFC- differentiating demonstrated the necessity of combining MFC evaluation with [A proof-of-concept for the extraction and evaluation of bone marrow radiomics features of [

Due to the high morbidity and mortality of infective endocarditis (IE), medical imaging techniques are combined to ensure a correct diagnosis. [A segmentation tool to extract quantitative measures of [Results show an overall increase in the metabolic uptake of the prosthetic valve ring in the studies with confirmed PVIE diagnosis (SUVThe proposed new method and presented software solution (CASSIA) provide the capability to assess quantitatively myocardial metabolism along the prosthetic valve region in routine [

This chapter will analyse personalization within the context of technological innovation. It will first of all clarify the conceptual terms used in the debate, in particular patient, person-centered and people-centered care and their various uses and limitations. It will then focus on specific issues of personalization and technology in emerging areas, notably in interprofessional practices and in medical training. This will allow greater understanding of both the possibilities and emerging tensions in the integration of personalization and technological innovation in healthcare systems from the training stage to its integration in various professional cadres.

Objective The aim of the study was to assess the impact of clinical and metabolic parameters derived from 18F-FDG PET/CT (positron emission tomography–computed tomography) in patients with locally advanced cervical cancer (LACC) on prognosis. Methods Patients with LACC of stage IB2-IVA treated by primary radiochemotherapy followed by brachytherapy were enrolled in this retrospective study. Indexes derived from standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and textural features of the primary tumor were measured for each patient. Overall survival (OS) and recurrence-free survival (RFS) rates were calculated according to Kaplan–Meier and survival curves were compared using the log-rank test. Uni- and multivariate analyses were performed using the Cox regression model. Results A total of 116 patients were included. Median follow-up was 58 months (range: 1–129). A total of 36 (31%) patients died. Five-year OS and RFS rates were 69 and 60%, respectively. Univariate analyses indicated that FIGO stage, the presence of hydronephrosis, high CYFRA 21.1 levels, and textural features had a significant impact on OS and RFS. MTV as well as SCC-Ag concentration were also significantly associated with OS. On multivariate analysis, the presence of hydronephrosis, CYFRA 21.1, and sphericity were independent prognostics factors for OS and RFS. Also, SCC-Ag level, MTV, and GLZLM (gray-level zone length matrix) ZLNU (zone length non-uniformity) were significantly associated with OS. Conclusion Classical prognostic factors and tumor heterogeneity on pretreatment PET/CT were significantly associated with prognosis in patients with LACC.

Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness’ metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants’ expertise. The results show that both the mean normalized GSR signal and average surgical instrument’s acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.

Purpose Chemotherapy-induced cardiotoxicity is one of the main complications during and after cancer treatment. While echocardiography is the most used technique in clinical practice to evaluate left ventricular (LV) dysfunction, a multimodal approach is preferred for the early detection of anthracycline-induced cardiotoxicity. In this paper, an image processing tool allowing the qualitative and quantitative analysis of myocardial metabolic activity by [18F]fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) images, acquired routinely during and after cancer treatment, is presented. Methods The methodology is based on cardiac single photon emission computed tomography image processing protocols used in clinical practice. LV polar maps are created, and quantitative regional values are calculated. The tool was validated in a study group of 24 patients with Hodgkin or non-Hodgkin lymphoma (HL and NHL, respectively) treated with anthracyclines. Staging, interim and end-of-treatment [18F]FDG PET/CT images were acquired and the presented tool was used to extract the quantitative metrics of LV metabolic activity. Results Results show an overall increase of metabolic activity in the interim PET image acquired while on treatment compared to staging PET, which then decreased in the end-of-treatment scan. Positive correlation coefficients between staging and interim scans, and negative correlation coefficients between interim and end-of-treatment scans also support this finding. Metabolic changes occur predominantly in the septal region. Conclusion The proposed methodology and presented software solution provides the capability to assess quantitatively myocardial metabolism acquired by routine [18F]FDG PET/CT scanning during cancer treatment for evaluating anthracycline-induced cardiotoxicity. The [18F]FDG PET/CT septal-lateral uptake ratio is proposed as a new quantitative measure of myocardial metabolism. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-021-02508-9

Amyloid positron emission tomography (PET) brain imaging with radiotracers like [18F]florbetapir (FBP) or [18F]flutemetamol (FMM) is frequently used for the diagnosis of Alzheimer’s disease. Quantitative analysis is usually performed with standardized uptake value ratios (SUVR), which are calculated by normalizing to a reference region. However, the reference region could present high variability in longitudinal studies. Texture features based on the grey-level co-occurrence matrix, also called Haralick features (HF), are evaluated in this study to discriminate between amyloid-positive and negative cases. A retrospective study cohort of 66 patients with amyloid PET images (30 [18F]FBP and 36 [18F]FMM) was selected and SUVRs and 6 HFs were extracted from 13 cortical volumes of interest. Mann–Whitney U-tests were performed to analyze differences of the features between amyloid positive and negative cases. Receiver operating characteristic (ROC) curves were computed and their area under the curve (AUC) was calculated to study the discriminatory capability of the features. SUVR proved to be the most significant feature among all tests with AUCs between 0.692 and 0.989. All HFs except correlation also showed good performance. AUCs of up to 0.949 were obtained with the HFs. These results suggest the potential use of texture features for the classification of amyloid PET images.

BACKGROUND: The increasing number of patients with acquired brain injury and the current subjectivity of the conventional upper extremity (UE) assessment tests require new objective assessment techniques. OBJECTIVE: This research proposes a novel objective motor assessment (OMA) methodology based on the Fugl-Meyer assessment (FMA). The goals are to automatically calculate the objective scores (OSs) of FMA-UE movements (as well as a global OS) and to interpret the estimated OSs. METHODS: Fifteen patients participated in the study. The OMA algorithm was designed to detect small-scale variations in UE movements. The OSs for 14 FMA-UE movements and the global OSs were automatically calculated using the algorithm and evaluated by 2 therapists. The interpretation of the global OSs was performed at 3 levels: by item, movement and globally. RESULTS: The global OSs calculated by our algorithm had a significant correlation with the therapists' scores (0.783 and 0.938

Healthy daily activities have a positive influence on many aspects of our lives. Habits have a deep impact on our health, they help to prevent the appearance of chronic and neurodegenerative diseases and will provide a healthy and active aging. This research work is aiming to analyze the need of new approaches on monitoring daily life activities, investigating new technologies and user modelling methods for healthy habits monitoring. mHealth platforms allow to perform a multivariable monitoring for allowing effective and personalized interventions. Data analytics, data mining and gamification methodologies are being applied to investigate user experience models. This user adaptation is commonly focused on personality and mood monitoring. Furthermore, new user models are built based on monitoring data, personality of user and the daily activity patterns extracted from intelligent and personalized monitoring. The final goal is contributing to improve user´s adherence to interventions, quality of life and quality of care in mHealth applications.

Depression is a mental disorder which can become a serious health problem. This research line is focused on creating a depression detection service from text analysis. Sentiment Analysis and Natural Language Processing methods will be used to develop this service. The service will classify text in positive or negative depending on the emotions inferred from user’s input texts. In this study, five classifiers have been evaluated to determine which one fits better for this purpose. Naive Bayes, Decision Tree, Naive Bayes based on Bernoulli model and Maximum Entropy are the classifiers analyzed. A specific corpus which includes sentences that fit research needs was designed for testing purposes, whereas Sentiment140’s corpus was used with training purposes. An evaluation methodology formed by three tests was designed. Results show a promising starting point, but further analysis will be needed. Future related works will focus on expanding classification to get user’s mood and not only a binary classification. It will allow to include this service as input for developing personalized intervention and education mHealth systems.

Positron emission tomography (PET) with amyloid binding tracers and 18F-fluordesoxyglucose (FDG) is used in the diagnosis of Alzheimer’s disease and other dementias. The dual-phase amyloid PET protocol acquires an early perfusion image immediately after the radiotracer injection that resembles FDG images. We studied the correlation of early phase 18F-florbetapir (eFBP) and FDG PET images by the quantitation of regional radiotracer uptake. Subjects with a neurodegenerative disease and eFBP and FDG PET scans were retrospectively selected. The PET images were normalized to the Montreal Neurological Institute template using Statistical Parametric Mapping version 12. Regional standardized uptake value ratios (SUVR) were extracted with the cerebellum serving as the reference region. Pearson’s correlation tests were performed to evaluate the regional correlation between eFBP and FDG PET images based on the quantitative measurements. Overall high correlation coefficients of up to r = 0.95 were observed in cortical regions that are in line with other studies or exceed previous results.

Cooperative relationships between groups are difficult because of the high human capability to differentiate between in-group vs. out-group members. This obstacle exists even when the groups can obtain benefits for themselves from cooperation with other groups (rational cooperation). Based on an interactionist approach, the authors propose that personal (individual differences) and situational (conflicts) factors contribute to rational intergroup cooperation. The authors conducted a preliminary correlational study (Study 1) and an experimental investigation (Study 2). In Study 1, the authors examined, with 105 participants, the psychometric properties of the Spanish version of the Rational–Experiential Inventory (REI), measuring individual differences in information processing. In Study 2, the authors conducted an experimental investigation with 141 participants, testing the role of individual differences and conflict in intergroup rational cooperation. Findings of Study 1 showed that the scale ha...

In this article, we described a new mobile-Health (mHealth) supported clinical pathway of care for people living with medically stable HIV in terms of platform acceptability, usability and technical feasibility. The EmERGE mHealth platform was codesigned with clinicians and the community, developed using Scrum agile methodology, integrated with hospital information systems and validated in a large prospective cohort study of 2251 participants. The evaluation of this new paradigm of care was conducted using a tailored Health Technology Assessment: the Model for Assessment of Telemedicine Applications. Usability and acceptability were assessed through the System Usability Score and a Patient Reported Experience Measure. The EmERGE platform was successfully deployed across diverse care settings in five European countries and used by 2251 patients and more than 20 clinicians for up to 30 months. Results from the formal evaluation demonstrated that the EmERGE platform is feasible and acceptable, with a high level of usability (median System Usability Score (SUS) 85.0%) and very positive patient-reported experiences (94.2% would recommend to a friend). The EmERGE platform is a secure and General Data Protection Regulation (GDPR)-compliant system with a complete set of functionalities that could be easily adapted to other clinical conditions, clinical sites and health systems thanks to its modular technical architecture.

Surgeons’ procedural skills and intraoperative decision making are key elements of clinical practice. However, the objective assessment of these skills remains a challenge to this day. Surgical workflow analysis (SWA) is emerging as a powerful tool to solve this issue in surgical educational environments in real time. Typically, SWA makes use of video signals to automatically identify the surgical phase. We hypothesize that the analysis of surgeons’ speech using natural language processing (NLP) can provide deeper insight into the surgical decision-making processes. As a preliminary step, this study proposes to use audio signals registered in the educational operating room (OR) to classify the phases of a laparoscopic cholecystectomy (LC). To do this, we firstly created a database with the transcriptions of audio recorded in surgical educational environments and their corresponding phase. Secondly, we compared the performance of four feature extraction techniques and four machine learning models to find the most appropriate model for phase recognition. The best resulting model was a support vector machine (SVM) coupled to a hidden-Markov model (HMM), trained with features obtained with Word2Vec (82.95% average accuracy). The analysis of this model’s confusion matrix shows that some phrases are misplaced due to the similarity in the words used. The study of the model’s temporal component suggests that further attention should be paid to accurately detect surgeons’ normal conversation. This study proves that speech-based classification of LC phases can be effectively achieved. This lays the foundation for the use of audio signals for SWA, to create a framework of LC to be used in surgical training, especially for the training and assessment of procedural and decision-making skills (e.g., to assess residents’ procedural knowledge and their ability to react to adverse situations).

VR P300-based BCI has proven to be a suitable method for training social attention skills in youngsters with autism spectrum disorder (ASD). In this study, we present a method that could be used in such an application to identify which object the user is paying attention to in a virtual environment by means of EEG recordings only. Temporal and time-frequency features were explored. Furthermore, the prediction accuracy of linear and nonlinear classification methods was assessed and compared, along with their computational times and complexity, and linear discriminant analysis (LDA) yielded the best overall performance (82%). The successful predictions and low computational times demonstrate the feasibility of the proposed solution for a VR-BCI neurorehabilitation tool.

Introducción: El análisis del movimiento es una valiosa herramienta para la evaluación de las habilidades psicomotrices en la laparoscopia. Sin embargo, requiere tecnologías para el seguimiento de la actividad de los instrumentos laparoscópicos durante el entrenamiento. En este artículo presentamos una técnica sin sensores para realizar el seguimiento de los movimientos de los instrumentos laparoscópicos basado en un sistema de cámara ortogonal y procesamiento de imágenes de video. Método: Los movimientos de los instrumentos laparoscópicos son capturados con dos cámaras web colocadas en configuración ortogonal. La posición y la orientación en el espacio de trabajo tridimensional se obtienen utilizando marcadores de color colocados en la punta de los instrumentos. Resultados: Las pruebas de precisión mostraron una resolución de 0.14 mm para el desplazamiento, con 1694 cm3 de espacio de trabajo total y 0.54° en los movimientos angulares. Los errores relativos medios del sistema de seguimiento fueron

Background Motion analysis parameters (MAPs) have been extensively validated for assessment of minimally invasive surgical skills. However, there are discrepancies on how specific MAPs, tasks, and skills match with each other, reflecting that motion analysis cannot be generalized independently of the learning outcomes of a task. Additionally, there is a lack of knowledge on the meaning of motion analysis in terms of surgical skills, making difficult the provision of meaningful, didactic feedback. In this study, new higher significance MAPs (HSMAPs) are proposed, validated, and discussed for the assessment of technical skills in box trainers, based on principal component analysis (PCA). Methods Motion analysis data were collected from 25 volunteers performing three box trainer tasks (peg grasping/PG, pattern cutting/PC, knot suturing/KS) using the EVA tracking system. PCA was applied on 10 MAPs for each task and hand. Principal components were trimmed to those accounting for an explained variance >80% to define the HSMAPs. Individual contributions of MAPs to HSMAPs were obtained by loading analysis and varimax rotation. Construct validity of the new HSMAPs was carried out at two levels of experience based on number of surgeries. Results Three new HSMAPs per hand were defined for PG and PC tasks, and two per hand for KS task. PG presented validity for HSMAPs related to insecurity and economy of space. PC showed validity for HSMAPs related to cutting efficacy, peripheral unawareness, and confidence. Finally, KS presented validity for HSMAPs related with economy of space and knotting security. Conclusions PCA-defined HSMAPs can be used for technical skills’ assessment. Construct validation and expert knowledge can be combined to infer how competences are acquired in box trainer tasks. These findings can be exploited to provide residents with meaningful feedback on performance. Future works will compare the new HSMAPs with valid scoring systems such as GOALS.

This research presents a novel low-cost pedagogical environment oriented to ease the use experiential learning methods for training on image-guided robotic surgery technologies. The environment proposes a simplified surgical simulation use case: the movement of insertion and extraction of a needle, similar to an image-guided biopsy situation. The training environment is composed of a 3D-printed phantom, a CT scan of the phantom, a virtual reality environment that includes haptic information, an ad-hoc 1 degree of freedom (DOF) robotic system for insertion/extraction and a Novint Falcon, a low cost 3 DOF manipulator that allows achieving haptic feedback. A first pilot experience has been carried out in the ?Surgical Simulation and Planning? course of the Bachelor of Biomedical Engineering at Universidad Politécnica de Madrid (UPM). Results of the surveys carried out (by teachers and learners) show that the new project-based methodology improves in all cases the values of student?s satisfaction obtained using the classical methodology based on master classes and practices.

This manuexamines whether the effect of anchoring bias is greater when citizens evaluate the quality of a publicservice after receiving negative initial information about service performance than after receiving positive information.It also tests whether there are differences in this anchoring bias by comparing formal (report) vs. informal (rumor)communication. Two field experiments were conducted with the participation of passengers of a commuter public traintransportation organization (Experiment 1, N = 105) and users of a public university administrative service (Experiment 2,N = 172). The first experiment confirmed the bias produced by the negative initial information, whereas this bias does notexist for the positive information. The second experiment showed that the bias produced by the initial information hasthe same magnitude for both formal and informal communication. This paper concludes with a discussion of theoreticaland practical implications for managing reputation in public services. Este manuscrito examina si el efecto del sesgo de anclaje es mayor cuando los ciudadanos evalúan la calidad de un serviciopúblico después de recibir información inicial negativa sobre la calidad del servicio, que después de recibir informaciónpositiva. También pone a prueba si hay diferencias en este sesgo de anclaje al comparar la comunicación formal (informe)con la comunicación informal (rumor). Se realizaron dos experimentos de campo con la participación de pasajerosde una compañía pública de trenes de cercanías (experimento 1, N = 105) y usuarios del servicio administrativo de unauniversidad pública (experimento 2, N = 172). El primer experimento confirmó el sesgo producido por la informacióninicial negativa, mientras que este sesgo no existe para la información positiva. El segundo experimento mostró que elsesgo producido por la información inicial tiene la misma magnitud tanto para la comunicación formal como para lainformal. El trabajo concluye con una discusión de las implicaciones teóricas y prácticas para la gestión de la reputaciónde los servicios públicos.

We propose a fully automated methodology for hexahedral meshing of patient-specific structures of the human knee obtained from magnetic resonance images, i.e. femoral/tibial cartilages and menisci. We select eight patients from the Osteoarthritis Initiative and validate our methodology using MATLAB on a laptop computer. We obtain the patient-specific meshes in an average of three minutes, while faithfully representing the geometries with well-shaped elements. We hope to provide a fundamentally different means to test hypotheses on the mechanisms of disease progression by integrating our patient-specific FE meshes with data from individual patients. Download both our meshes and software at http://im.engr.uconn.edu/downloads.php.

Background Diffuse Large B cell lymphoma (DLBCL) is usually diagnosed between the 5th-6th decade of life. Its incidence increases with age. Chemotherapy (CT) with R-CHOP is the standard treatment for any age. However, in the clinical practice, alternative treatments with less toxicities are offered to elderly patients. This group of patients is usually not well represented in clinical trials. Our aim is to asses the benefit of standard treatment in this population, as well as discontinuation of treatment and its impact on overall survival (OS). As secondary endpoint, we have analyzed the survival rate in the subgroup of patients older than 75 years of age treated with CT. Methods A retrospective review was performed in patients ≥65 years who were diagnosed with DLBCL during the years 2013-2015 in the Hospital of Leon. Patients with histological confirmation of the primary diagnosis and who received treatment were included. Results 65 patients were analyzed. The average age was 75 years. 64% were male and 30% had stage 4 disease at the time of diagnosis. The CT schemes were: R-CHOP (N = 28), R-CEOP (N = 11) and R-miniCHOP (N = 8). 10 patients had grade 4 AEs. One death ocurred after receiving the first cicle. 70% completed at least 4 cicles of CT. Median OS was 51 months versus (vs) 11 months in favor of R-CHOP group (HR = 0,59, p = 0,112 IC 95%=0,30-1,13). Results were not statistically significant likely because of the small sample size. 45% of patients had a complete response, 20% had a partial response and 10% had no response to treatment.The main cause of death was disease progression. Median OS was 15 months in both groups, in patients older than 75 treated with CT vs Conclusions In clinical practice, age is an important variable to account for when deciding on the management approach for heamatological malignancies such as DLBCL. Although our results show a non-statistically significant benefit in OS of R-CHOP vs other schemes, this could be due to the small sample size. Given the prevalence of elderly population in our country, and the proved benefit of standard chemotherapy in the approach of DLBCL, more studies are needed. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Introduction: E-learning web environments, including the new TELMA platform, are increasingly being used to provide cognitive training in minimally invasive surgery (MIS) to surgeons. A complete validation of this MIS elearning platform has been performed to determine whether it complies with the three web quality dimensions: usability, content and functionality. Methods: 21 Surgeons participated in the validation trials. They performed a set of tasks in the TELMA platform, where an e-MIS validity approach was followed. Subjective (questionnaires and checklists) and objective (web analytics) metrics were analysed to achieve the complete validation of usability, content and functionality. Results: The TELMA platform allowed access to didactic content with easy and intuitive navigation. Surgeons performed all tasks with a close-to-ideal number of clicks and amount of time. They considered the design of the website to be consistent (95.24%), organised (90.48%) and attractive (85.71%). Moreover, they gave the content a high score (4.06 out of 5) and considered it adequate for teaching purposes. The surgeons scored the professional language and content (4.35), logo (4.24) and recommendations (4.20) the highest. Regarding functionality, the TELMA platform received an acceptance of 95.24% for navigation and 90.48% for interactivity. Conclusions: According to the study, it seems that TELMA had an attractive design, innovative content and interactive navigation, which are three key features of an e-learning platform. TELMA successfully met the three criteria necessary for consideration as a website of quality by achieving more than 70% of agreements regarding all usability, content and functionality items validated; this constitutes a preliminary requirement for an effective e-learning platform. However, the content completeness, authoring tool and registration process required improvement. Finally, the e-MIS validity methodology used to measure the three dimensions of web quality in this work can be applied to other clinical areas or training fields.

Laparoscopic surgery is commonly used in many surgical procedures but requires a learning process to develop the necessary skills. Virtual reality simulators play an essential role within the training curricula. This paper aims to determine whether training in SINERGIA VR simulator allows novice surgeons to improve their basic psychomotor laparoscopic skills.Forty-two people participated in this study, including 28 unexperience medical students and 14 expert surgeons who developed previously more than 100 laparoscopic procedures. Medical students made a pre-training test in LapMentor II; then, they trained in SINERGIA and they finally accomplished a post-training test in LapMentor II. Experts just made one trial in LapMentor II. A statistical analysis was carried out and results of pre- and post-training tests of novices were compared with Wilcoxon signed-rank test. Pre- and post-training tests of novices were also compared with results of experts with Mann-Whitney U test.Most metrics provided by LapMentor II and included in this study show significant differences when comparing pre- and post-training tests of novices. Analysis of pre-training test of novices and experts results show significant differences in all analyzed metrics for all studied tasks. On the other hand, LapMentor was not able to distinguish between experts and novices after training in SINERGIA for any metric in the camera manipulation task and for some metrics of the other tasks.Training in SINERGIA VR simulator allows improvement of basic psychomotor laparoscpic skills and transferring them to another virtual simulator. Therefore, it could be used in laparoscopic surgery training programs.

One of the most important revolutions in the past few decades in clinical practice has been motivated by the introduction of Minimally Invasive Surgery (MIS) techniques, which have spread amongst almost all surgical specialities. MIS training is a principal component of the education of new surgical residents, with an increasing demand for knowledge and skills for medical students and surgeons. Technology enhanced learning (TEL) solutions can deal with the growing need for MIS learning. This research work aims to develop a MIS learning environment based on web technologies, named TELMA, which will respond to the growing amount of information and multimedia surgical contents available (mainly intervention’s video recording libraries), in compliance with specific learning needs of surgical students and professionals, enhancing their competence on MIS cognitive skills. Furthermore, TELMA will support knowledge capturing, sharing and reuse, and effective management of didactic contents through personalised and collaborative services.

In this paper, the development of an assisting system for laparoscopic surgical training is presented. With this system, we expect to facilitate the training process at the first stages of training in laparoscopic surgery and to contribute to an objective evaluation of surgical skills. To achieve this, we propose the insertion of multimedia contents and outlines of work adapted to the level of experience of trainees and the detection of the movements of the laparoscopic instrument into the monitored image. A module to track the instrument is implemented focusing on the tip of the laparoscopic tool. This tracking method does not need the presence of artificial marks or special colours to distinguish the instruments. Similarly, the system has another method based on visual tracking to localize support multimedia content in a stable position of the field of vision. Therefore, this position of the support content is adapted to the movements of the camera or the working area. Experimental results are presented to show the feasibility of the proposed system for assisting in laparoscopic surgical training.

Due to limitations in conventional medical imaging and the restrictions imposed by both the anatomy and the surgical approach in pancreatic cancer, there is a need for methods to support intraoperative imaging in order to improve their accurate anatomical localization and the characterization of their nature. Laparoscopic ultrasounds (LUS) images and endoscopic videos can be used to extract useful information during the surgical procedures. A fast approach for acquiring an estimation of the tumor positioning and size through laparoscopic ultrasounds images has been developed. Based on the surgical video, endoscope 3D tracking is achieved by means of a Shape-from-Motion technique. Intraoperative imaging algorithms’ validation has been carried out in an ex vivo porcine model and results have shown the viability of exploiting them for structures characterization and their 3D reconstruction.

La necesidad de desarrollar nuevos implantes basados en materiales bioactivos que sean capaces de soportar grandes cargas mecánicas ha llevado a la producción de sustratos metálicos recubiertos con cerámicas bioactivas. Recientemente se ha propuesto un dispositivo alternativo que consiste en un sustrato de carburo de silicio (SiC) biomórfico recubierto con vidrio bioactivo, mediante la técnica de Depósito por Láser Pulsado (PLD), y que dispone de la resistencia mecánica adecuada, además de gran ligereza y una porosidad intrínseca muy favorable de cara a la implantación. En este trabajo se presenta un estudio interdisciplinar de este nuevo material centrado en la morfología y porosidad de sustratos de SiC provenientes de diferentes maderas, la bioactividad de los recubrimientos producidos por PLD y en la evaluación in vitro con células de osteosarcoma MG-63 con la que se ha determinado la citotoxicidad de estos materiales y se ha estudiado la influencia de los mismos en la adhesión y la proliferación celular. In the past years there was a need to develop new tough bioactive materials capable to resist high loads when implanted in the body, that led to the production of bioactive coatings on metallic substrates. A new approach, which consists of biomorphic silicon carbide (SiC) coated with bioactive glass by Pulsed Laser Deposition (PLD), was recently presented. This new material joins the high mechanical strength, lightness and porosity of biomorphic SiC and the bioactive properties of PLD glass films. In this work, a multiple evaluation of this new material is presented starting from the biomorphic SiC morphology and porosity, following with the bioactivity in simulated body fluid of the coatings, and ending with a deep in vitro study with MG-63 cells. The citotoxicity of the SiC coated and uncoated and the cell proliferation and attachment were studied.

Pulsed laser deposition (PLD) is a promising technique to produce bioactive glass coatings due to unique characteristic that allows depositing multicomponent films in stoichiometric composition. Moreover, when the ablation experiments are conducted in the presence of a reactive atmosphere (reactive pulsed laser deposition) the film composition can be enriched as compared to that of the basic target and the film properties can be tailored by varying the ambient gas pressure. In this work, the influence of different reactive atmospheres (N 2 O, H 2 O, NH 3 , Ar) and the role of the total pressure on the PLD bioactive glass film properties have been investigated. The coatings were produced by ablating a silica-based bioactive glass target with an ArF laser beam (193 nm, 4.17 J cm −2 ). Films were grown on silicon substrates at 200 °C. The bonding configuration changes were followed by Fourier transform infrared spectroscopy and the film thickness was measured by profilometry. The infrared spectra reveal that an oxidant environment (N 2 O, H 2 O) promotes the reduction of the non-bridging silicon–oxygen groups (Si O NBO) and the incorporation of carbonate groups and adsorbed water, while a NH 3 and Ar atmosphere favours the formation of Si O NBO groups. The total pressure of the atmosphere also plays an important role on the film properties. When the Ar pressure is increased, a gradual shifting of the Si O stretching vibration to higher wavenumbers, the incorporation of carbonates and the diminution of the Si O NBO groups were observed.

Bioactive glasses of different composition were ablated in vacuum with an ArF laser to investigate the transfer of the multi-component system to titanium substrates. Both the bioactive coatings and the bulk glasses were analysed by Rutherford backscattering spectrometry (RBS), particle induced X-ray emission (PIXE), nuclear reaction analysis (NRA), Fourier transform infrared (FTIR) and X-ray photoelectron spectroscopies (XPS). The composition analyses by RBS, PIXE and NRA reveal that the target stoichiometry is nearly congruent transferred to the coating. Nevertheless, along the thin film slight inhomogeneities in composition were found. On the other hand, XPS and FTIR spectra show important changes in the bonding configuration of the coatings and a diminution of the non-bridging oxygen functional groups. This new rearrangement of the coating network forming and modifying agents strongly impacts the bioactive behaviour of the films when soaked in simulated body fluids.

Amorphous hydrogenated silicon–carbon layers have been prepared on silicon and aluminium substrates by photo-chemical vapour deposition from silane and ethylene by using a Xe 2 * excimer lamp. Films produced at different substrate temperatures have been systematically characterised by ellipsometry, Fourier Transform Infrared Spectroscopy (FTIR), profilometry, Raman Spectroscopy and Energy Dispersive X-ray Spectroscopy (EDS). Ellipsometric studies reveal that the refractive index rises linearly from 1.5 to 2.3 and the deposition rate changes significantly when the substrate temperature is increased. Moreover, EDS analysis indicates an enhancement of the silicon to carbon ratio. Homonuclear silicon and carbon bonds are observed in the Raman spectra, and infrared spectroscopy shows hydrogen incorporated in the films bonded to both silicon and carbon atoms. An atypical increase of the amount of Si–H and a shift of its stretching frequency is found for increasing temperatures. Spontaneous effusion of hydrogen bonded to silicon and a consequent incorporation of oxygen in these vacancies, which provokes a diminution of the refractive index and a shift of the Si–H stretching frequency to higher values, is observed during film aging.

This paper presents the AMELIE Authoring Tool for e-health applications. AMELIE provides the means for creating video-based contents with a focus on e-learning and telerehabilitation processes. The main core of AMELIE lies in the efficient exploitation of raw multimedia resources, which may be already available at clinical centers or recorded ad hoc for learning purposes by health professionals. Three real use cases scenarios involving different target users are presented: (1) cognitive skills? training of surgeons in minimally invasive surgery (medical professionals), (2) training of informal carers for elderly home assistance and (3) cognitive rehabilitation of patients with acquired brain injury. Preliminary validation in the field of surgery hints at the potential of AMELIE; and its versatility in different medical applications is patent from the use cases described. Regardless, new validation studies are planned in the three main application areas identified in this work.

The present work covers the first validation efforts of the EVA Tracking System for the assessment of minimally invasive surgery (MIS) psychomotor skills. Instrument movements were recorded for 42 surgeons (4 expert, 22 residents, 16 novice medical students) and analyzed for a box trainer peg transfer task. Construct validation was established for 7/9 motion analysis parameters (MAPs). Concurrent validation was determined for 8/9 MAPs against the TrEndo Tracking System. Finally, automatic determination of surgical proficiency based on the MAPs was sought by 3 different approaches to supervised classification (LDA, SVM, ANFIS), with accuracy results of 61.9%, 83.3% and 80.9% respectively. Results not only reflect on the validation of EVA for skills’ assessment, but also on the relevance of motion analysis of instruments in the determination of surgical competence.

Acquired Brain Injury (ABI) has become one of the most common causes of neurological disability in developed countries. Cognitive disorders result in a loss of independence and therefore patients? quality of life. Cognitive rehabilitation aims to promote patients? skills to achieve their highest degree of personal autonomy. New technologies such as interactive video, whereby real situations of daily living are reproduced within a controlled virtual environment, enable the design of personalized therapies with a high level of generalization and a great ecological validity. This paper presents a graphical tool that allows neuropsychologists to design, modify, and configure interactive video therapeutic activities, through the combination of graphic and natural language. The tool has been validated creating several Activities of Daily Living and a preliminary usability evaluation has been performed showing a good clinical acceptance in the definition of complex interactive video therapies for cognitive rehabilitation.

Cognitive impairment is the main cause of disability in developed societies. New interactive technologies help therapists in neurorehabilitation in order to increase patients' autonomy and quality of life. This work proposes Interactive Video (IV) as a technology to develop cognitive rehabilitation tasks based on Activities of Daily Living (ADL). ADL cognitive task has been developed and integrated with eye-tracking technology for task interaction and patients' performance monitoring.

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules.

Purpose Laparoscopic techniques have nowadays become a gold standard in many surgical procedures, but they imply a more difficult learning skills process. Simulators have a fundamental role in the formative stage of new surgeons. This paper presents the construct and face validity of SINERGIA laparoscopic virtual reality simulator in order to decide whether it can be considered as an assessment tool. Methods Twenty people participated in this study, 14 were novices and 6 were experts. Five tasks of SINERGIA were included in the study: coordination, navigation, navigation and touch, precise grasping and coordinate traction. For each one of these tasks, a certain number of metrics are automatically recorded. All subjects accomplished each task only once and filled in two questionnaires. A statistical analysis was made and results from both groups were compared with the Mann–Whitney U-test, considering significant differences when P ≤ 0.05. Internal consistency of the system has been analyzed with the Cronbach’s alpha test. Results Novices and experts positively rated SINERGIA characteristics. At least one of the evaluated metrics of each exercise presented significant differences between both groups. Nevertheless, all metrics under study gave a better punctuation to the executions accomplished by experts (lower time, higher efficiency, fewer errors. . .) than to those made by novices. Conclusion SINERGIA laparoscopic virtual reality simulator is able to discriminate subjects according to their level of experience in laparoscopic surgery; therefore, it can be used within a training program as an assessment tool

Video-endoscopic image analysis is an important source of information for extracting relevant 3D information of the surgical scene in minimally invasive surgery. This work proposes a new approach for getting depth information and relative position between instruments and organs based on video image analysis. The proposed image analysis extracts information from: (1) the projective geometry of the surgical setting in the image to determine laparoscopic tool’s pose, and (2) the scene illumination captured in the image for getting a depth-map of the surgical scene. Results have verified the potential of video-analysis based methods for obtaining 3D information of the whole surgical scene. This information offers new possibilities for developing new augmented reality surgical applications and for improving surgical training with objective metrics. The main benefit of this approach is the lack of extra elements which disturb surgeons’ performance in the clinical routine.

A trend in abdominal surgery is the transition from minimally invasive surgery to surgeries where augmented reality is used. Endoscopic video images are proposed to be employed for extracting useful information to help surgeons performing the operating techniques. This work introduces an illumination model into the design of automatic segmentation algorithms and 3D reconstruction methods. Results obtained from the implementation of our methods to real images are supposed to be an initial step useful for designing new methodologies that will help surgeons operating MIS techniques.

Vision-based tracking of laparoscopic tools offers new possibilities for improving surgical training and for developing new augmented reality surgical applications. We present an original method to determine not only the tip position, but also the orientation of a laparoscopic tool respect to the camera coordinate frame. A simple mathematical formulation shows how segmented tool edges and camera field of view define the tool 3D orientation. Then, 3D position of the tool tip is determined by image 2D coordinates of any known point of the tool and by tool's diameter. Accuracy is evaluated in real image sequences with known ground truth. Results show a positioning error of 9,28 mmRMS, what is explained by inaccuracies in the estimation of tool edges. The main advantage of proposed method is its robustness to occlusions of the tool tip.

Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery.